Government’s head of HIV/AIDS, Dr Nono Simelela, says she has been “spending sleepless nights asking what we are to do with mother-to-child-transmission if we can’t have nevirapine”.

“I have 80 000 women on this programme. I have to have an answer for them,” Simelela told media shortly before the opening of the first South African AIDS conference in Durban on Sunday (3 August).

This follows the Medicines Control Council’s (MCC) decision last week to reject the Ugandan study which declared the drug safe and effective in preventing mother-to-child HIV transmission.

Simelela said the Department of Health was “informed about the MCC decision at the same time as it hit the media”, and that it was “not privy to correspondence between the MCC and nevirapine’s manufacturer, Boehringer Ingelheim”.

“We still have to formulate our Plan B. The Minister needs to meet with the MECs to consider the decision. We have a responsibility in terms of the Constitutional Court to ensure PMTCT,” said Simelela.

The Constitutional Court ruled last year that government had to offer nevirapine or a suitable alternative to pregnant women with HIV.

The MCC has given Boehringer Ingelheim 90 days to provide other evidence that its drug is safe for PMTC, something the manufacturer says it doubts it will be able to do.

Conference chairperson Prof Jerry Coovadia said the nevirapine decision had come as a shock, but that such shocks could be avoided if there was a body that brought policy makers and scientists together.

Coovadia said there was a danger of “democratic anarchy” unless government had recourse to “the best available science”.

UN Special Envoy on AIDS, Stephen Lewis, said that most African countries were using nevirapine for their PMTCT programmes.

“Africa is entering a desperate and difficult period as the [HIV] infections become full-blown AIDS, and there is a sense that the worst is still to come,” said Lewis, who has just completed a tour of Uganda, Rwanda and Mozambique.

African countries were “obsessed with treatment” as there was a “desperate feeling that they need to keep people alive [yet] had reached a point of no return”.

Lewis said that while changing male sexual behaviour had to be addressed, this would take generations as there was “nothing more obdurate”.

However, the empowerment of women “can be done more rapidly” and there was “no time to lose to stop losing all the women that we are at present”. – Health-e News Service.